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21 December 2008 @ 12:38 pm

That is really what this whole Journey from start to finish comes down to for me.  Decisions I am willing to live with.  Perhaps the other side of “choices I am willing to live with” is RISK.   In fact perhaps they are not on opposite, but the same side.  These two go hand in hand.

What risk am I willing to live with vs what risk am I not willing to live with?

I am no longer willing to live with the up to 87% risk of breast cancer.

There are other options before considering mastectomy surgery.  There is of course surveillance, there is a drug called tamoxifen which is said to reduce risk by up to 50%.  Other women choose to have their ovaries removed which is also said to reduce our breast cancer risk by a good amound. At this point in my life I am not willing to live with any of these options.

That brings us to surgery.  According to some experts, having healthy breast tissue removed may be the most appropriate preventative approach for those of us carrying the BRCA mutation.  It will reduce my risk by 90%.  That is something I am willing to live with.


I will make it really basic.  Essentially there are 2 ‘kinds’ of reconstruction surgery. Tissue 'FLAP' surgery or Implants.  Within both of these options there are many different surgeries.

FLAP surgery.  It is when they use a tissue flap from your own body to reconstruct the breast(s) that was (were) taken.  They can take these tissue flaps from your abdomen, buttocks and even your back. One of the wonderful things about these types of surgery is that the final ‘breast’ is very like the original.  Because it is made from your own fatty tissue, feels and even moves like a normal breast.  It is also a permanent fix.  There will be no need to change it out 15 yrs down the road.  On the flip side, it means not just one surgery (mastectomy) it means a second major surgery to collect the flaps, these are done at the same time.  Generally the surgery will leave quite a large scar at the donation site.  The recovery time from this kind of procedure is quite a bit longer and more difficult than other options.

This is not a surgery I was willing to have.  I did not want the extra scars, the more complicated and more painful recovery or the ‘real feeling’ breasts.  As odd as it may sound I am very much looking forward to being able to wear whatever I please without having to wear a bra!

This brings us to Implant reconstruction;  when they place an implant to replace the breast tissue.  There are different ways of doing this surgery too.  There is what they call a One-Step with Alloderm, One-Step Expander/Implants and Tissue Expander w/Implant.  Every Dr. will have their favourite.   Most Dr’s don’t do more than one of these surgeries. 

There is a wonderful book that I highly recommend reading, it gives a brief but very informative breakdown of each surgery.  The book is called "The Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery" by Kathy Steligo.  It was the first book I picked up when I decided to do the surgery and was by far the most useful as well.  This is the website: www.breastrecon.com/index.html

I chose to go with the Tissue Expander and Impant.  The there are really two reasons why I did.  First, is that the Dr I wanted to go with did this kind of reconstruction (unless I wanted the flap surgery).  Second is that the other two ‘ways’ are still fairly new.  I wanted to reduce my risk of complications as much as I could and for my peace of mind; it meant going the ‘traditional tissue expander’ route.

The choices I made were the right ones for me.  They are decisions and choices that I made and are willing to live.  Are they the same choices you should make?  I cannot say.  I know that you must make the choices that are right for you; they may not be the same ones I made.  YOU must live with them.


Before going ahead with the surgery I went over in my head the worse case scenarios.  Hopefully none of these would be an issue, but at least if I consider them before hand, there will be no surprises after surgery.  It may seem morbid, but I had to do it before going on.  

Here’s my list of worse case scenarios as far as surgery and recover go.
  • I die.  Yes.  That would be the WORSE thing that could happen. The chances of that happening are VERY slim.  I didn’t look up the statistics, but I can assure you it is very unlikely.  :)  Even if it did happen; I have the blessed assurance of knowing where I will be spending eternity.
  • I have to remove one or both expanders and be flat.  Sometimes a person’s body just cannot adjust to a foreign object.  Maybe it will be infection or other complications that will cause this to happen. Considering my risk of breast cancer will be reduced by what it will be – would I be able to live with a flat chest?  The answer is yes.  If I was not comfortable being flat, there are many prostheses available to women today.
  • I have complications.  The healing takes MUCH longer than expected.  Necrosis, seroma, infection. There are many things that can go wrong during the healing process...  I have just reduced my risk of breast cancer by 90%, would dealing with these issues be worth it?  Yes. It may take time, but we can DEAL with them as they come.  Much better to deal with these complications than with a cancer diagnosis.
For me it takes the scariness away when I see and consider the ‘bad’ things that can happen.  Now that I’ve seen and considered them, I can now let it go and stop worrying/obsessing about them.

Not that I am wishing or hoping any of these things to happen.  I’m not.  But I am aware they can happen.  To go in blindly and expecting all to go well, for me, was not an option.  I know the things that can go wrong and we (my husband and I) will deal with them as they come.   

Whatever could go wrong would be worth it; compared to doing nothing and perhaps having to fight cancer later.